RESUMO
This study evaluated patients' knowledge on the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) and their perception of this risk when it is presented as a relative risk (RR), absolute risk (AbR) or attributable risk (AR). This was a cross-sectional study involving 159 users or potential users of COCs. The participants answered a self-administered questionnaire in which the risk of VTE associated with COCs was presented as RR, AbR and AR. The degree of concern expressed regarding this risk and the women's changes of opinion when the information was communicated through a different risk model were evaluated. Most of the women (67.9%) expressed concern when the risk was presented as an RR. Conversely, they showed no concern when the risk was presented as an AbR (14.5%) or AR (10.7%). A significant number of women changed their opinion regarding their level of concern when the risk was presented as an AbR or AR (p < 0.001). In conclusion, concerns about thrombotic complications from the use of combined hormonal contraception is reduced when incidence rather than relative risk is presented. Presentation of thrombosis complications in terms of incidence rather than RR may improve communication of side effects during counseling for combined hormonal contraception initiation.
Assuntos
Anticoncepcionais Orais Combinados/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Educação de Pacientes como Assunto , Tromboembolia Venosa/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Fatores de Risco , Adulto JovemRESUMO
This prospective observational study was designed to determine the percentage of hysterectomies avoided following insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) in perimenopausal women with uterine fibroids and a prior indication for surgery. The study also compared the progress of patients using the LNG-IUS with those submitted to hysterectomy, with particular emphasis on the patient's satisfaction with treatment. Sixty perimenopausal patients with uterine fibroids and excessive bleeding referred for hysterectomy were included. After counseling on the possibility of non-surgical treatment, 39 patients opted to use an LNG-IUS while 21 opted for hysterectomy. Continuation of LNG-IUS use and the patient's satisfaction with the chosen procedure were assessed. A secondary analysis evaluated hemoglobin levels, clinical complications, bleeding patterns and uterine volume at ultrasonography over time. After 24 months of follow-up, four of the patients who had opted to use an LNG-IUS were submitted to surgery, while 35 continued using the device, thus avoiding hysterectomy in 89.5% of cases. LNG-IUS users were more satisfied with treatment (p = 0.02) compared to those submitted to hysterectomy. In conclusion, the use of the LNG-IUS enables the number of hysterectomies to be reduced in women with uterine fibroids and is associated with greater satisfaction compared to surgical treatment.
Assuntos
Dispositivos Intrauterinos Medicados , Leiomioma/terapia , Levanogestrel/administração & dosagem , Hemorragia Uterina/terapia , Neoplasias Uterinas/terapia , Adulto , Feminino , Humanos , Histerectomia , Leiomioma/complicações , Estudos Longitudinais , Pessoa de Meia-Idade , Satisfação do Paciente , Perimenopausa , Estudos Prospectivos , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicaçõesRESUMO
INTRODUCTION: Although coronary heart disease in users of combined oral contraceptives (COCs) is rare, one of the principal risk factors for its occurrence is dyslipidemia. OBJECTIVE: To evaluate the prevalence of dyslipidemia in women wishing to use COCs, and its association with known clinical risk factors in order to evaluate the need to determine the lipid profile in this population. STUDY DESIGN: Cross-sectional study involving 516 women aged 18-40 years, 54% nulligravid, who wished to use COCs and presented no contraindications. Dyslipidemia was classified according to the National Cholesterol Educational Project Adult Treatment Panel III guidelines, which define levels of total cholesterol ≥ 200 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, triglycerides >150 mg/dL, and low-density lipoprotein cholesterol ≥ 160 mg/dL as an abnormal lipid profile. The lipid profile was determined, and the association between clinical risk factors and the presence of dyslipidemia was evaluated by the chi-squared test and logistic regression. The receiver operating characteristic curve was constructed to compare body mass index (BMI) and smoking relevance for dyslipidemia. RESULTS: The prevalence of dyslipidemia was 33.9%. Smoking and BMI were significantly associated with the presence of dyslipidemia, with sensitivity of 31.3-54% and specificity of 41.9-67.7% for diagnosis of dyslipidemia, respectively. CONCLUSION: The high prevalence of dyslipidemia could justify lipid profile evaluation before prescribing a COC. BMI and smoking represent modest predictive markers for the presence of dyslipidemia in candidates for the use of combined oral contraceptives.
Assuntos
Anticoncepcionais Orais/efeitos adversos , Dislipidemias/induzido quimicamente , Lipídeos/sangue , Adolescente , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Monitoramento de Medicamentos , Dislipidemias/sangue , Dislipidemias/epidemiologia , Dislipidemias/etiologia , Feminino , Hospitais Universitários , Humanos , Obesidade/fisiopatologia , Ambulatório Hospitalar , Sobrepeso/fisiopatologia , Prevalência , Curva ROC , Fatores de Risco , Fumar/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: To evaluate the impact of estrogen therapy on microalbuminuria levels in healthy post-menopausal women. METHODS: Sixty post-menopausal women were evaluated in a prospective, randomised, double-blind, placebo-controlled study. The patients were randomly allocated to one of two groups to take one pill orally per day containing either 1 mg of 17beta-estradiol (E(2) group) or placebo (placebo group). Prior to initiating treatment and at the end of the sixth treatment month, microalbumin was measured in a 12-h urine sample, and lipid profile (total cholesterol, HDL, LDL and triglycerides) and fasting glucose were evaluated. Comparative intra- and inter-group analyses between the initial and final laboratory parameters were performed using the t-test for paired samples and for independent samples, respectively. RESULTS: Microalbuminuria levels remained within normal limits throughout the study and no statistically significant differences were found in the intra- or inter-group analyses. With respect to lipid profile, alterations characteristically encountered during use of estrogen replacement therapy were found. No statistically significant variation in glucose levels occurred during the study period. CONCLUSION: Estrogen replacement therapy had no significant effect on microalbuminuria levels in healthy post-menopausal patients.